Accommodating intraocular lens with outer support structure

ABSTRACT

An intraocular lens for insertion into the capsular bag of an eye contains an optic, an outer periphery, and an outer support structure. The optic has a periphery and centered about an optical axis. The outer periphery is disposed about the optic and configured to engage an equatorial region of the capsular bag of an eye. The outer support structure is disposed along the periphery and spaced from the optic with voids outer support structure and the optic. The intraocular lens further comprises a first intermediate member and a weakened region disposed along the outer periphery between the outer support structure and the first intermediate member. The first intermediate member operably couples the optic and the outer support structure. The weakened region is attached to, and configured to provide relative motion between, the outer support structure and the first intermediate member in response to the ciliary muscle of the eye.

RELATED APPLICATIONS

This application is a Continuation-In-Part application of U.S. patentapplication Ser. No. 10/661,410, filed Sep. 12, 2003, now U.S. Pat. No.7,150,759, which is a Continuation-In-Part of U.S. patent applicationSer. No. 10/341,701, filed Jan. 14, 2003, now U.S. Pat. No. 7,025,783,which claimed the benefit of provisional application Ser. No.60/348,705, filed Jan. 14, 2002, and provisional application Ser. No.60/372,309, filed Apr. 12, 2002.

BACKGROUND OF THE INVENTION

The present invention relates to intraocular lenses (IOLs). Moreparticularly, the present invention relates to IOLs that provideaccommodating movement in the eye.

The human visual system includes the eyes, the extraocular muscles whichcontrol eye position within the eye socket, the optic and other nervesthat connect the eyes to the brain, and particular areas of the brainthat are in neural communication with the eyes. Each eye forms an imageupon a vast array of light sensitive photoreceptors of the retina. Thecornea is the primary refracting surface which admits light through theanterior part of the outer surface of the eye. The iris contains muscleswhich alter the size of the entrance port of the eye, or pupil. Thecrystalline lens has a variable shape within the capsular bag, under theindirect control of the ciliary muscle. Having a refractive index higherthan the surrounding media, the crystalline lens gives the eye avariable focal length, allowing accommodation to objects at varyingdistances from the eye.

Much of the remainder of the eye is filled with fluids and materialsunder pressure which help the eye maintain its shape. For example, theaqueous humor fills the anterior chamber between the cornea and theiris, and the vitreous humor fills the majority of the volume of the eyein the vitreous chamber behind the lens. The crystalline lens iscontained within a third chamber of the eye, the posterior chamber,which is positioned between the anterior and vitreous chambers.

The human eye is susceptible to numerous disorders and diseases, anumber of which attack the crystalline lens. For example, cataracts marvision through cloudy or opaque discoloration of the lens of the eye.Cataracts often result in partial or complete blindness. If this is thecase, the crystalline lens can be removed and replaced with anintraocular lens, or IOL.

While restoring vision, conventional IOLs have limited ability foraccommodation (i.e., the focusing on near objects). This condition isknown as presbyopia. To overcome presbyopia of an IOL, a patient may beprescribed eyeglasses. Alternative attempts in the art to overcomepresbyopia focus on providing IOLs with accommodation ability.Accommodation may be accomplished by either changing the shape of atleast one optic surface of the IOL, by moving the IOL along its opticalaxis, or some combination of the two. These and similar approaches forproviding accommodation are disclosed, for example, in the followingU.S. patents and patent applications, all of which are hereinincorporated by reference: U.S. Pat. Nos. 4,373,218; 4,601,545;4,816,031; 4,892,543; 4,994,083; 5,066,301; 5,108,429; 5,171,266;5,203,788; 6,176,878; 6,406,494; 6,443,985; 6,599,317; 6,616,692;6,638,305; 6,645,246; 2003/0060881; 2003/0158599; 2004/0034415;2004/0082993; 2005/0131535; and U.S. patent application Ser. No.09/656,661, filed in Sep. 7, 2000.

Despite these various devices and method of providing accommodation,there continues to be a need, to provide new IOLs with enhancedaccommodative capabilities.

SUMMARY OF THE INVENTION

In one aspect of the invention, an intraocular lens for insertion intothe capsular bag of an eye comprises an optic, an outer periphery, anouter support structure. The optic has a periphery and centered about anoptical axis. The outer periphery is configured to engage an equatorialregion of the capsular bag of an eye and the outer support structure isdisposed along the outer periphery of the intraocular lens and is spacedfrom the optic with voids therebetween. The intraocular lens furthercomprises a first intermediate member operably coupled to the optic andthe outer support structure. The intraocular lens also comprises firstand second weakened regions disposed along the outer periphery. Each ofthe weakened regions may be disposed between the outer support structureand the first intermediate member. The weakened regions are configuredto allow relative motion between the outer support structure and thefirst intermediate member in response to the ciliary muscle of the eye.In certain embodiments, the relative motion is an angular motion betweenthe first intermediate member and the outer support structure.

In certain embodiments, the outer support structure surrounds orentirely surrounds the optic and/or the intermediate members. In otherembodiments, the outer support structure is connected to distal ends ofthe first and second intermediate members. In such embodiments, theweakened regions are disposed along the outer periphery to either sideof and/or proximal to the distal ends. The outer periphery may becircular or elliptical or some other shape that is suited for insertioninto the eye, for example, into the capsular bag.

In another aspect of the invention, the intraocular lens furthercomprises a second, or even three or more, intermediate member(s)extending between and operably coupling the optic and the outer supportstructure. In such embodiments, the intraocular lens may comprise firstweakened regions disposed along the outer periphery between the outersupport structure and the intermediate members, as well as secondweakened regions disposed along the outer periphery between the outersupport structure and the intermediate members. The first and secondweakened regions may be configured to allow angular motion between theouter support structure and the intermediate members in response to theciliary muscle and/or capsular bag. In some embodiments, the outersupport structure further comprises at least one intermediate weakenedregion circumferentially disposed between intermediate members. Theintermediate weakened regions may be circumferentially disposedequidistant between intermediate members or otherwise disposed toprovide a predetermined performance of the outer support structure orintraocular lens when the outer support structure is compressed orstretched.

The weakened regions may be configured or formed in various way toprovide the predetermined performance of the outer support structure orintraocular lens. For example, one or more of the weakened regions maycomprise a hinge. Also, one or more of the weakened regions may have aradial thickness that is less than a radial thickness of the outersupport structure in a region proximal the at least one weakened region.Additionally or alternatively, the weakened regions may have a thicknessalong the optical axis that is less than a thickness along the opticalaxis of the outer support structure in a region proximal the at leastone weakened region. In some embodiments, the outer support structure ismade of a first material and at least one of the weakened regions ismade of a second material that is more bendable than the first material.

In yet another aspect of the invention, the outer support structurecomprises a first arm and the second arm with a void therebetween. Insuch embodiments, at least a portion of the first arm may be slidablydisposed to at least a portion of the second arm.

Another aspect of the invention involves an intraocular lens forinsertion into the capsular bag of an eye comprising an optic, an outersupport structure having an outer periphery, a first intermediatemember, and a weakened region disposed proximal to the firstintermediate member and along the outer periphery of the intraocularlens. The optic has a periphery and is centered about an optical axis.The first intermediate member extends between and is operably coupled tothe optic and the outer support structure. The outer support structureentirely and continuously surrounds the optic and is spaced from theoptic and there are one or more voids between the outer supportstructure and the optic. The outer support structure is configured toengage an equatorial region of the capsular bag of an eye. The weakenedregion is configured to allow relative motion between the outer supportstructure and the first intermediate member in response to the ciliarymuscle of the eye.

Each and every feature described herein, and each and every combinationof two or more of such features, is included within the scope of thepresent invention provided that the features included in such acombination are not mutually inconsistent.

BRIEF DESCRIPTION OF THE DRAWINGS

Additional aspects, features, and advantages of the present inventionare set forth in the following description and claims, particularly whenconsidered in conjunction with the accompanying drawings in which likeparts bear like reference numbers.

FIG. 1 is a vertical cross-section of an eye illustrating an exemplaryintraocular lens of the present invention positioned within the capsularbag;

FIG. 2 is a cross-section similar to FIG. 1 showing forward or anteriormovement of an optic of the intraocular lens;

FIG. 3 is a plan view of the exemplary intraocular lens of the presentinvention having an oval outer ring and a pair of nonlinear intermediatemembers;

FIG. 4 is a plan view of an alternative intraocular lens of the presentinvention having two radially oriented intermediate members;

FIG. 5 is a plan view of an alternative intraocular lens of the presentinvention having three radially oriented intermediate members;

FIG. 6 is a perspective view of an alternative intraocular lens of thepresent invention having three radially oriented intermediate members;

FIG. 6A is an elevational view of one edge of the intraocular lens ofFIG. 6;

FIG. 7A is a perspective posterior view of a still further alternativeintraocular lens of the present invention having three radially orientedplate-like intermediate members and an optic that is bowed slightly outof the plane of a surrounding capsular bag support ring;

FIG. 7B is a perspective anterior view of the intraocular lens of FIG.7A;

FIGS. 7C and 7D are plan and side elevational views, respectively, ofthe intraocular lens of FIG. 7A;

FIG. 7E is a sectional view taken through line 7E-7E of FIG. 7B;

FIG. 8A is a perspective view of a still further alternative intraocularlens of the present invention having two radially oriented plate-likeintermediate members connecting a central optic to an oval surroundingcapsular bag support ring;

FIG. 8B is another perspective view of the intraocular lens of FIG. 8A;and

FIGS. 8C and 8D are side elevational and plan views, respectively, ofthe intraocular lens of FIG. 8A.

FIG. 9 is a plan view of another alternate embodiment of the invention;

FIG. 10 is a plan view of still another alternate embodiment of theinvention;

FIG. 11 is a plan view of an outer ring according to yet anotherembodiment of the invention;

FIG. 12 is a plan view of an outer ring according to another embodimentof the invention; and

FIG. 13 is a plan view of a outer ring according to still anotherembodiment of the invention;

FIG. 14 is a plan view of a outer ring according to still anotherembodiment of the invention;

FIG. 15 is a fragmentary perspective posterior view showing a portion ofa support ring structured to bend in an anterior direction;

FIG. 16 is a fragmentary perspective anterior view showing a supportring structured to bend in a posterior direction;

FIG. 17 is a view similar to FIG. 7B, showing an embodiment of theinvention having an alternate hinge configuration;

FIG. 18A is an anterior plan view showing yet another embodiment of anintraocular lens according to the present invention;

FIG. 18B is a sectional view taken through line B-B of FIG. 18A;

FIG. 18C is a sectional view taken through line C-C of FIG. 18A; and

FIG. 19 is a fragmentary perspective anterior view showing a supportring structured to bend both posteriorly and radially outwardly.

FIG. 20 is a plan view of an IOL having weakened portions according toembodiments of the present invention.

FIG. 21 is a plan view of another embodiment of an IOL having weakenedportions.

FIG. 22 is a plan view of an IOL having weakened portions made of adifferent material than other portion of the IOL.

FIG. 23 is a plan view of an IOL having weakened portions and a voidbetween arms of the IOL.

FIG. 24 is a plan view of another embodiment of an IOL having weakenedportions and a void between arms of the IOL.

FIG. 25 is a plan view of an IOL having a circular outer support ringand weakened portions.

FIG. 26 is a side view of an optic from an IOL according to embodimentsof the invention wherein the optic is not compressed.

FIG. 27 is a side view of an optic from an IOL according to embodimentsof the invention wherein the optic is compressed.

DETAILED DESCRIPTION OF THE DRAWINGS

Referring to the drawings in more detail, an intraocular lens (IOL) 20according to an exemplary embodiment of the present invention isillustrated in FIGS. 1 and 2 after implantation in the capsular bag 22of an eye. Exemplary IOL 20 includes an optic 24 and a movement assembly26 coupled thereto. The optic 24, which has an optical axis OA, isadapted to focus light onto a retina of an eye. The movement assembly 26of exemplary IOL 20 cooperates with the eye to effect accommodatingmovement of the optic 24 and, in particular, converts radial movement(i.e., movement perpendicular to the optical axis OA) of the capsularbag of an eye to axial movement (i.e., movement parallel to the opticalaxis OA) of the optic 24. In the exemplary embodiment, the movementassembly 26 biases the optic 24 in a posterior direction (to the right)against the posterior wall of the capsular bag 22.

With further reference to FIG. 3, which illustrates the exemplary IOL 20in plan view, the optic 24 comprises a generally circular periphery orperipheral edge 42 that defines the radially outer extent of the optic24 and separates a posterior face from an anterior face. The optic 24 istypically circular, but may exhibit a different shape as long as theoptical correction character is centered about the optical axis OA. Theoptic 24 may be bi-convex, or the anterior and posterior faces can takeother shapes, such as planar or concave. In any event, the posteriorface and anterior face are spaced apart on opposite sides of an opticplane (not shown) that extends perpendicular to the optical axis OA. Inother words, the optic 24 is centered on and oriented in the opticplane.

The movement assembly 26 may further comprise a pair of intermediatemembers 50 a, 50 b connected to and extending between the circularperiphery 42 of the optic 24 and an outer ring 52. Each intermediatemember 50 a, 50 b has an inner end 54 connected to the circularperiphery 42, and an outer end 56 connected to the outer ring 52. Asused herein in this context, the term “connected” means firmly attachedto, for example, by using an adhesive or ultrasonic bond, by formingintegrally, or by forming as a cohesive single piece. In the lattercase, the lens is desirably molded. Each intermediate member 50 a, 50 bis desirably oriented in a plane that is in the optic plane. Indeed, theintermediate members 50 a, 50 b and outer ring 52 may have approximatelythe same thickness and be located in the same plane.

A brief description of the anatomy of the eye is appropriate in order tounderstand the invention. The capsular bag 22 resides in the posteriorchamber of the eye and is in direct contact with the jelly-like vitreoushumor 28 which fills the nearly spherical space between the capsular bagand the retina (not shown). In a healthy person, the capsular bag 22contains the natural crystalline lens which transmits light passingthrough the orifice of the iris 30 to the retina. The capsular bag 22 isconnected to an annular ciliary muscle 34 by suspensory ligaments orzonules 36. The ciliary muscle 34 is the chief agent in accommodation,i.e., in adjusting the eye to focus on near objects. The zonules 36retain the lens in position and are relaxed by the contraction of theciliary muscle 34, thereby allowing a natural crystalline lens to becomemore convex.

In certain embodiments, the optic 24 is monofocal optic. In suchembodiments, the anterior and posterior surfaces of the optic 24 mayhave spherical profiles. Alternatively, at least one of the anterior andposterior surfaces of the optic 24 may have an aspheric profile, forexample, as discussed in U.S. Pat. No. 6,609,793, which is hereinincorporated by reference. In other embodiments, the optic 24 is amultifocal optic having a plurality of zones of varying optical powers,wherein the maximum add power of the near zones is reduced by an amountequivalent to the diopter shift obtained through axial movement of theoptic 24. Thus, the net power correction in the near zones is equal tothe patient's full add prescription only when optic 24 has moved to thenear distance (i.e., anteriormost) position. Examples of suitablemultifocal optics are disclosed in Lang et al. U.S. Pat. No. 6,231,603and Lang et al. PCT International Application No. WO/01/82839 A1. Thedisclosures of both the U.S. patent and the PCT internationalapplication are incorporated in their entireties herein by reference.

Although controlled fibrosis (i.e., cellular growth) on the outer ring52 may be desirable, the IOLs 20 of the invention inhibit cell growth,particularly epithelial cell growth, onto the optic 24. This isaccomplished by configuring the periphery 42 of the optic 24 withmechanical barriers such as relatively sharp posterior and/or anterioredge corners, for example, as disclosed in U.S. Pat. Nos. 6,162,249,6,468,306, and 6,884,262. The proliferation of unwanted epithelial cellgrowth may also be inhibited through the use of material properties.

The intermediate members 50 a, 50 b of the IOL 20 are substantiallylonger than previous intermediate members as they extend in a nonlinearfashion from the outer ring 52 to the circular optic periphery 42. Moreparticularly, the inner end 54 and outer end 56 are angularly spacedabout the optical axis OA by at least approximately 90 degrees. Themid-portion of each intermediate member 50 extends in a serpentinefashion between its inner and outer ends.

In certain embodiments, as seen in FIG. 3, the outer ring 52 is oval inshape and has a major axis 60 perpendicular to the optical axis OA. Aminor axis 62 extends perpendicularly to the major axis 60 and to theoptical axis OA. Desirably, the outer ends 56 of the intermediatemembers 50 connect to the oval ring 52 along the major axis 60. In thisway, the length of the intermediate members 50 is maximized. In theillustrated embodiment, the inner ends 54 of the intermediate members 50connect to the circular optic periphery 42 along the minor axis 62.Therefore, the inner and outer ends 54, 56 are angularly spaced apart byabout 90 degrees.

FIG. 4 illustrates an alternative IOL 70 of the present invention havingan optic 72, an oval outer ring 74, and a pair of intermediate members76 a, 76 b extending radially therebetween. Again, the optic 72, outerring 74 and intermediate members 76 a, 76 b are desirably formed as asingle homogeneous (i.e., integral) piece. In certain embodiments, theoval outer ring 74 may move the optic 72 axially with greatereffectiveness than a circular ring because of the orientation of theintermediate members 76 a,b along the major axis.

The fixation members 76 a,b are shown as plate-like, and desirably aregreater in width (the dimension parallel to the minor axis) than axialthickness (the dimension parallel to the optical axis). Preferably, theratio of width to axial thickness is about four. In absolute terms, thewidth of the fixation members 76 a, 76 b may be between about 0.8 mm andabout 3.0 mm.

FIG. 5 illustrates a still further IOL 80 having an optic 82, an outerring 84, and three evenly arranged and radially oriented intermediatemembers 86 a, 86 b and 86 c. Because the intermediate members 86 are notsymmetric about any plane through the optical axis OA, forces exerted bythe surrounding capsular bag do not act in opposition to one another andthus may be translated more effectively into axial movement of the optic82. The radial thickness t_(r) of the outer ring 84 is indicated, and isdesirably in the range of 0.2-0.6 mm. Moreover, the corners, or at leastone corner, of the outer peripheral edge of the outer ring 84 aredesirably relatively sharp to reduce the instance of epithelial cellgrowth thereon.

FIGS. 6 and 6A illustrate a still further IOL 90 of the presentinvention having an optic 92, a plurality of intermediate members 94extending radially outward therefrom, and an outer ring 96. The edgesurface 97 of the outer ring 96 may be contoured to conform to the innerwall of the capsular bag. Therefore, as seen in FIG. 6A, at least aportion 98 of the edge surface 97 is convexly outwardly curved. At thesame time, at least one corner, in this case the posterior corner 99, isleft sharp (i.e., unpolished) to form a barrier against posteriorcapsular opacification (PCO).

Furthermore, FIG. 6 illustrates the greater axial thickness t_(a) of theouter ring 96 with respect to the axial thickness of the intermediatemembers 94 and optic 92. Specifically, the axial thickness t_(a) of theouter ring 96 is desirably between about 0.4 mm and about 1.0 mm.Without wishing to limit the invention to any particular theory ofoperation, it is believed that a ring having an axial thickness in thisrange will place both the posterior and the anterior zonules of the eyeunder tension. Thus, both sets of zonules work in unison to change thediameter of the capsular bag in response to action of the ciliarymuscle, resulting in axial movement of the optic. In some embodiments, athinner ring would not interact as effectively with both sets ofzonules, and thus, in all likelihood, would result in less axialmovement.

In addition, an outer ring 96 having increased axial thickness willincrease the pressure on the sharp corner 99 of the edge surface 97 toincrease the barrier effect of the ring against PCO.

FIGS. 7A-7E show another IOL 100 of the present invention having acircular outer capsular bag support ring 102, an inner optic 104, and amovement system comprising a plurality of radially-oriented plate-likeintermediate members 106 extending therebetween. Preferably, the optic104, whether it be bi-convex or otherwise, is circumscribed by acircular rim 105 to which the fixation intermediate members 106 aredirectly attached. The rim 105 desirably has a constant axial dimensionand helps to reduce glare while not increasing incision size.

Movement systems other than that shown may be suitable, such as a moresolid interface rather than discrete intermediate members. However,separated intermediate members with voids therebetween and between theoptic 104 and support ring 102 are preferred. The support ring 102,inner optic 104, and intermediate members 106 are firmly attached toeach other with adhesive or ultrasonic bonding, or preferably formedintegrally, i.e., molded or machined as one cohesive (homogeneous) pieceof material. The IOL 100 is desirably liquid injection molded fromsilicone or machined from a hydrophilic material which fabricationprocess reduces cost and increases quality and/or consistency of theproduct.

FIG. 7A illustrates the IOL 100 from the posterior side, while FIG. 7Bis an anterior view. These two views show the axial position at whichthe intermediate members 106 attach to the support ring 102. That is,the support ring 102 has an axial dimension and the intermediate members106 attach to a posterior edge thereof. When implanted, the intermediatemembers 106 and connected optic 104 are therefore held in aposterior-most position with respect to the support ring 102.

As in the embodiment of FIG. 6, the edge surface of the outer ring 102is contoured to facilitate implantation within the capsular bag of thepatient. More particularly, the support ring 102 has an outer surfacethat is convexly curved to better mate with the concave inner wallportion of the capsular bag between the anterior and posterior zonules.

With reference to FIGS. 7C and 7E, the intermediate members 106 comprisea radially inner portion 108, a radially outer portion 110, and a hinge112 therebetween. The inner and outer portions 108, 110 are generallyplate-like having larger circumferential dimensions than axialdimensions. The hinge 112 may be formed in a number of ways, and asillustrated comprises a region wherein both the axial and thecircumferential thickness are reduced by about 50% with respect to theinner and outer portions 108, 110. Alternatively, only one of the axialand the circumferential thicknesses are reduced as compared to theremaining portions of the intermediate member 106. The reduced materialat the hinge 112 means that it is weaker than the remaining portions ofthe intermediate member and thus will more easily bend at that location.In other embodiments, the hinge 112 has the same axial and thecircumferential thickness as the remaining portions of the intermediatemember 106. In such embodiments, the hinge 112 may be made of adifferent material or from the same material that is processeddifferently from the remaining portions of the intermediate member 106(e.g., with a differing amount of polymerization). The location of eachhinge 112 is desirably the same for all of the fixation intermediatemembers 106, and preferably is closer to the support ring 102 than tothe optic 104. For example, each hinge 112 may be located about 60% ofthe way from the optic 104 to the support ring 102. In some embodiments,the intermediate member 106 has no distinct hinge such as the hinge 112,for example, as illustrated in FIGS. 4 and 5 for the IOLs 70 and 80,respectively. In such embodiments, the entire intermediate member (e.g.,intermediate members 76 a or 86 a) may bend to allow the optic of theIOL to translate anteriorly and posteriorly in response to the ciliarymuscle 34.

FIG. 7D illustrates the IOL 100 in an elevational view wherein thesupport ring 102 lies substantially in a plane and the optic 104projects in a posterior direction therefrom by virtue of the shape ofthe intermediate members 106. Specifically, the intermediate members 106are bowed slightly in the posterior direction such that the optic 104will tend to lie against or closely adjacent to the posterior wall ofthe capsular bag. Relaxation of the ciliary muscles 34 surrounding thecapsular bag 22 either moves the optic 104 or changes the posterior biasimparted thereto by the intermediate members 106. As a result, thevitreous humor behind the capsular bag can move the optic 106 so as toallow a subject to focus both on distant and relatively near objects.

In one exemplary embodiment, the support ring 102 has a diameter ofbetween about 9.0-10.5 mm, and an axial thickness of about 0.7 mm.Furthermore, the support ring 102 has a curvature that mimics thecurvature of the natural capsular bag between the anterior and posteriorzonules, which curvature is between about 0.3-1.0 mm. As mentionedabove, at least one corner edge of the outer ring is left sharp to helpprevent cell growth thereon. In other embodiments, the support ring 102may be sized to have a diameter that provides a predetermined fit withinthe capsular bag 22, for example when the eye is in an accommodativestate, a disaccommodative state, or a state somewhere between theaccommodative and disaccommodative states. IOLs 100 may be configured tohave a plurality of diameters to provide a predetermined fit withindifferent size capsular bags 22 for different eyes. Preferably, thediameter of the support ring 102 is between about 8 mm and at leastabout 13 mm, more preferably between 8 mm and 12 mm, and even morepreferably between 9 mm and 11 mm.

Although three radial intermediate members 106 are illustrated 120degrees apart, the configuration of the intermediate members 106 mayvary. However, two factors that are believed to facilitate axialmovement, or accommodation, of the optic 104 are the tripod orientationand presence of the hinges 112. More specifically, inward radial forcesfrom the surrounding ciliary muscle 34 and intermediary zonules 36 aretransmitted from the support ring 102 through the intermediate members106 to the optic 104. Because the intermediate members 106 are orientedso that none is diametrically opposed to another, there are no directlyopposing forces and a larger component therefore translates into axialmovement of the optic 104.

The intermediate members 106 are plate-like to increase stability of thelens in the eye. That is, the forces imparted by the surrounding ciliarymuscle 34 may not be entirely uniform and may exert torsional forces onthe lens. Plate-like intermediate members 106 help resist twisting ofthe lens and thus increase stability. The circumferential thickness, orwidth, of the intermediate members 106 may be between about 1.5-4.0 mm,and the axial thickness is desirably between about 0.2-0.5 mm.

FIG. 17 shows an alternate embodiment of an IOL 102′ substantiallysimilar to the embodiment of FIGS. 7A-7E, except that the thickness ofthe hinge portion 112′ is reduced in the axial direction only. That is,the circumferential thickness, or width, of each plate-like intermediatemember 106′ is uniform throughout its length. This hinge configurationhas been found to be less susceptible to fibrosis than a hingeconfiguration having reduced thickness in the circumferential direction.

Another alternative IOL 120 of the present invention is seen in FIGS.8A-8D. As in an earlier embodiment, there are only two intermediatemembers 122 extending between an oval shaped outer capsular bag supportring 124 and an inner circular optic 126. In the illustrated embodiment,the outer ring 124 comprises a band having a generally rectangularcross-section with a longer axial than radial dimension. Preferably, atleast one corner of the outer ring 124 is sharp to prevent epithelialcell growth thereon. The support ring 124, inner optic 126, andintermediate members 122 are firmly attached to each other with adhesiveor ultrasonic bonding, or preferably formed integrally, i.e., molded ormachined as a cohesive single piece. The IOL 120 is desirably liquidinjection molded from silicone or machined from a hydrophilic materialwhich, again, reduces cost and increases quality and/or consistency ofthe product.

As seen best in FIG. 8D, the oval outer ring 124 has a major axis 121and a minor axis 123, and the two intermediate members 122 arediametrically opposed across the optic 126 along the major axis 123. Inone exemplary embodiment, the support ring 124 has a major diameter ofbetween about 115-135% of the minor diameter.

The intermediate members 122 are plate-like, each having a relativelylarger circumferential than axial dimension. In contrast to the IOL 100of FIGS. 7A-7D, the intermediate members 122 lie in a plane defined bythe oval-shaped outer ring 124, and thus the optic 126 is not bowedeither way. Furthermore, the intermediate members 122 are joined to theinner surface of the outer ring 124 at approximately the axial midpointthereof. Therefore, in contrast to the earlier embodiment, the optic 126is not positioned or biased to favor movement in one direction or theother.

With reference to FIG. 8A, each intermediate member 122 has a hinge 128therein located closer to the outer ring 124 than to the optic 126. Thelocation of each hinge 128 is desirably the same for all of theintermediate members 122, and preferably is located about 75% or more ofthe way from the optic 126 to the support ring 124. Empiricaldetermination of hinge 128 location optimizes the design such that lessradial and axial compression force is required to axially translate theoptic 126, while at the same time the ability of the lens to resisttwisting is not adversely affected. In the illustrated embodiment, thesehinges 128 are formed by reduced axial thickness portions along eachintermediate member 122. For example, curved troughs on both sides ofintermediate members 122 as shown may form the hinges. Alternatively, orin addition, the circumferential dimension of each intermediate member122 may be reduced.

As with the earlier embodiment, the optic 126, whether it be biconvex orotherwise, is recessed from a circular rim 130 to which the intermediatemembers 122 are directly attached. The rim 130 is slightly tapereddownward toward the optic and helps reduce glare on the lens. Desirably,the maximum axial dimension of the rim 130 is greater than the centerthickness of the optic 126. Advantageously, a reduced center thicknesspermits a reduction in incision size.

FIGS. 18A-18C show an alternate embodiment of an IOL 120′ similar to theembodiment of FIGS. 8A-8D, except that the optic 126′ is multifocal, andoval support ring 124′ has a non-uniform cross-sectional area.Alternatively, the optic 126′ may be a monofocal optic, as discussedelsewhere herein. In the illustrated embodiment, the radial thickness ofthe support ring 124′ increases from a minimum value t_(r1), forinstance about 0.2 mm, at diametrically opposed locations 125 a and 125b along the minor axis 121′, to a maximum value t_(r2), for instanceabout 0.6 mm, at diametrically opposed locations along the major axis123′, where the intermediate members 122′ are secured to the ring 124′.In addition, the axial thickness t_(a) of the ring 124′ is constantthroughout the entire circumference of the ring 124′ and has a valuegreater than the maximum radial thickness t_(r2).

The circumferential thickness, or width, of each intermediate member122′ is also non-uniform throughout its length, for instance decreasingin a non-linear fashion from a maximum width where the intermediatemember 122′ joins the circular rim 130′ of the optic 126′ to a minimumwidth at the hinge 128′, and remaining substantially constant betweenthe hinge 128′ and the outer ring 124′. This particular configuration ofthe oval outer ring 124′ and intermediate members 122′ has been found tobe particularly stable, with minimal “flopping”, twisting, or otherunwanted movement, of the thinnest portions 125 a and 125 b of the outerring 124′.

FIGS. 9-16 and 19-25 show alternate embodiments of the invention whereinthe support ring includes weakened portions configured to allow the ringto allow consistent and repeatable deformation during compression.

FIG. 9 shows an IOL 131 having an optic 132, an outer ring 134, and apair of plate-like intermediate members 136 a and 136 b. Theintermediate members 136 a and 136 b are shown without hinges, similarto the intermediate members 76 a and 76 b of FIG. 4, although hingedintermediate members could also be used. The outer ring 134 is generallyoval, with two generally arcuate ends 138, 140 that merge with thedistal ends of the intermediate members 136 a and 136 b, respectively,and two elongated leg portions 142, 144 that extend parallel to a majoraxis 146 of the outer ring 134 along opposite sides of the optic 132

A weakened portion 146 a, b is formed in each leg portion 142, 144 at alocation along the minor axis 147 of the support ring 134, such thateach weakened portion 146 a, b is 180 degrees away from the otherweakened portion 146 a, b and equidistant from the arcuate ends 138, 140of the outer ring 134. Each weakened portion 146 a, b is in the form ofa thinned area in one of the legs 142, 144, the thinned area beingcreated, in this embodiment, by providing a generally C-shapedindentation 148 a, b on each side of the leg. This configuration ensuresthat any bending or buckling of the outer ring 134 as a result ofcompressive forces on the distal ends 138, 140 of the outer ring 134will occur at the weakened portions rather than elsewhere along theouter ring 134. In some embodiments, the outer ring 134 comprises onlyone of indentations 148 a, b. In yet other embodiments, the outer ring134 comprises two or more weakened portions 146 a and two or moreweakened portions 146 b in order cause the outer ring 134 to deform in apredetermined manner in response to the ciliary muscle 34. In suchembodiments, the shape of each of at least some of the weakened portions146 a, b may be different from the shape of others of the weakenedportions 146 a, b in order to produce the desired response to theciliary muscle 34.

FIG. 10 shows an IOL 150, generally similar to IOL 80 of FIG. 5,comprising an optic 152, a circular outer ring 154 and three evenlyarranged and radially oriented intermediate members 156 a, 156 b, and156 c, which may be hingeless as shown, or hinged, for example, as inthe embodiment of FIGS. 7A-7D. The support ring 154 includes threeweakened areas 158 a, b, c provided 120 degrees from one another andradially equidistant from the intermediate members 156 a, 156 b, and156. Again, the weakened areas 158 a, b, and c, which are shown here asC-shaped indentations on each side of the outer ring 154, are configuredto ensure that any bending or buckling of the outer ring 154 occurs atthe three weakened area only, rather than at other locations along thering. In some embodiments, there may be two or more weaken areas 158 a,b, and c between each of the intermediate members 156 a, 156 b, and 156c in order to the outer ring 154 to deform in a predetermined manner inresponse to the ciliary muscle 34.

FIG. 11 shows an outer ring 160 according to an alternate embodiment ofthe invention wherein the weakened areas 162 a and 162 b are in the formof V-shaped indentations or grooves in the outer circumferential surface163 of the outer ring 160. An outer ring 160 having this configurationwill tend to bend or buckle in a radially inward direction at the twoweakened areas 162 a and 162 b when the outer ring 170 is subjected tocompressive forces.

FIG. 12 shows an outer ring 164 according to another embodiment of theinvention wherein the weakened areas 166 a and 166 b are in the form ofU-shaped indentations or grooves formed in the inner circumferentialsurface 168 of the outer ring 164. An outer ring 164 having thisconfiguration will tend to bend or buckle in a radially outwarddirection at the two weakened areas 166 a and 166 b when the outer ring164 is subjected to radially compressive forces.

In still another embodiment of the invention, shown in FIG. 13, theouter ring 170 is provided with four symmetrically arranged weakenedareas 172 a, b, c, and d, each in the form of a slit or notch in theouter circumferential surface 174 of the outer ring 170. An outer ring170 having this configuration will tend to bend or buckle in a radiallyinward direction at the four weakened areas when the outer ring 170 issubjected to radially compressive forces.

In yet another embodiment, shown in FIG. 14, a circular outer ring 176is provided with two thinned areas 178 a and 178 b on diametricallyopposite locations on the ring. Each thinned area is formed by providinga pair of U-shaped grooves or indentations in the ring 176, each pairconsisting of a first indentation 180 a in the outer circumferentialsurface 182 of the outer ring 176 and a second indentation 180 b in theinner circumferential surface 184 of the outer ring 176.

FIG. 15 is an enlarged fragmentary perspective view showing a weakenedportion 186 according to still another embodiment of the invention. Inthis embodiment, the weakened portion 186 comprises a thinned area,notch, indentation or groove formed in the posterior face 188 of theouter ring 190. An outer ring 190 having a plurality of weakenedportions 186 configured in this way will tend to bend in an anteriordirection (towards the cornea) at each of the weakened portions whensubjected to radially compressive forces.

Alternatively, a weakened portion 192 according to another embodiment ofthe invention may comprise a thinned area, notch, indentation or grooveformed in the anterior face 194 of the outer ring 196, as shown in FIG.16. An outer ring 196 having a plurality of weakened portions 192configured in this way will tend to bend in an posterior direction (awayfrom the cornea) at each of the weakened portions when subjected toradially compressive forces.

FIG. 19 shows yet another embodiment of the invention wherein a weakenedportion 198 is configured to cause bending in both a posterior and aradially outward direction. Although the weakened portion 198 is shownas a single notch formed at the corner 200 between the anterior surface202 and the inner circumferential surface 204, it could also be formedas a pair of intersecting notches, grooves or indentations, oneextending entirely across the anterior surface 202 and the otherextending entirely across the inner circumferential surface 204, or anyother equivalent configuration.

A weakened portion or portions could also be formed on any othercombination or intersection of surfaces, for instance at a cornerbetween a posterior surface and an outer circumferential surface tocause bending in anterior and radially inward directions, or at a cornerbetween an anterior surface and an outer circumferential surface tocause bending in posterior and radially inward directions. Various othercombinations of weakened portions will be readily apparent to theskilled practitioner, but for reasons of brevity will not be illustratedhere.

FIG. 20 illustrates still another embodiment of the invention wherein anIOL 300 comprises an optic 302 having a periphery 303 and centered aboutan optical axis OA, an outer support structure 304 disposed about theoptic 302 and spaced therefrom, and first and second intermediatemembers 308 a, 308 b extending between and operably coupling (and/ordirectly connected to) the optic 302 and the outer support structure304. The outer support structure 304 is disposed along an outerperiphery 305 of the IOL 300 and is configured to engage an equatorialregion of the capsular bag 22. The outer support structure 304 mayentirely and continuously surround the optic 302. That is, the outersupport structure 304 may form a closed or unbroken ring or loopcompletely around the optic 302. In some embodiments, the outer supportstructure 304 is coupled or attached to the first and/or secondintermediate members 308 a, b. For example, the outer support structure304 may be connected to distal ends 311 of the first and secondintermediate members 308 a, b. In such embodiments, the weakened regions310 a, b may be disposed along the outer periphery 305 to either side ofand/or proximal to the distal ends 311.

The IOL 300 further comprises one or more weakened regions, for example,the first and second weakened regions 310 a, b shown in FIG. 20,disposed along the outer periphery 305 between the outer supportstructure 304 and the first and second intermediate members 308 a, b.The first and second weakened regions 310 a, b are attached to the outersupport structure 304 and the first and second intermediate members 308a, b. The first and second weakened regions 310 a, b are also configuredto provide relative motion between the outer support structure 304 andthe first and second intermediate members 308 a, b in response to theciliary muscle 34.

The weakened regions 310 a, b are generally configured to allow angularmotion between the first intermediate member 308 a and the outer supportstructure 304 in response to the ciliary muscle 34. Depending upon thestructure of the weakened regions 310 a, b and the nature and directionof the forces applied to the IOL 300 by the ciliary muscle 34 and/or thecapsular bag 22, the weakened regions 310 a, b may additionally oralternatively allow relative linear motion between the between the firstintermediate member 308 a and the outer support structure 304 inresponse to the ciliary muscle 34.

With additional reference to FIG. 21, the outer support structure 304may further comprise one or more intermediate weakened regions 312 thatare circumferentially disposed between first and/or second intermediatemembers 308 a, b. The intermediate weakened regions 312 may be disposedat locations on the outer support structure 304 that will allow theouter support structure 304 to bend, buckle, or otherwise deform in apredetermined and/or desirable manner when the IOL 300 is compress bythe capsular bag 22 or is otherwise affected by force produced inresponse to the ciliary muscle 34. The weakened regions 310 a, b and 312may also be disposed so as to prevent or reduce unwanted deformationand/or twisting of either the optic 302 and/or the first and secondintermediate members 308 a, b.

The weakened regions 310 a, b and intermediate weakened regions 312 maycomprise various structures and/or material so as to provide apredetermined performance, bending, compression, and/or motion of theouter support structure 304 and the intermediate members 308 a, b inresponse to the ciliary muscle 34 and/or the capsular bag 22. Forexample, any of the configurations or arrangements shown in FIGS. 9-16may be used in conjunction with the IOL 300. Referring to theembodiments illustrated in FIGS. 20 and 21, one or more of the weakenedregions 310 a, b and 312 may have a radial thickness that is less than aradial thickness of the outer support structure in a region proximal theone or more weakened regions 310 a, b and 312. Additionally oralternatively, one or more of the weakened regions 310 a, b and 312 aredisposed on a top or bottom surface of the outer support structure 304and have a thickness along the optical axis OA that is less than athickness along the optical axis OA of the outer support structure 304in a region proximal the one or more weakened regions 310 a, b and 312.Also, one or more of the weakened regions 310 a, b and 312 may bedisposed along a corner edge of the outer support structure 304 similarto the configuration illustrated in FIG. 19. In the illustratedembodiments of FIGS. 20 and 21, the weakened regions 310 a, b and 312are disposed along an outer perimeter of the outer support structure304; however, some or all of the weakened regions 310 a, b and 312 maybe disposed along an inner perimeter, a top or bottom surface, or alonga corner edge of the outer support structure 304.

Referring to FIG. 22, in certain embodiments, the outer supportstructure 304 is made of a first material and one or more of theweakened regions 310 a, b and 312 are made of a second material that ismore bendable than the first material. For example, the first materialmay be relatively stiff or hard (e.g., having a relatively high modulusof elasticity or tensile strength), while the second material is arelatively pliable or soft (e.g., having a relatively low modulus ofelasticity or tensile strength). In certain embodiments, outer supportstructure 304 and one or more of the weakened regions 310 a, b and 312are made of the same material or substantially the same material, butthe material in the one or more of the weakened regions 310 a, b and 312is processed in a different way from the material in the outer supportstructure 304. For example, the degree of polymerization may bedifferent in the one or more of the weakened regions 310 a, b and 312than in the outer support structure 304. It will be understood thatwhile the weakened regions 310 a, b and 312 are shown as distinctregions in FIG. 22, these regions may be indistinguishable oressentially indistinguishable by visual inspection in an actual IOL.Also, the boundary between the weakened regions 310 a, b and 312 and theouter support structure may be extended, gradual, or non-existent. Forexample, the boundary may be defined, in certain embodiments, by agradual transition from the first material to the second material or bya gradual change in the degree of polymerization between the weakenedregions 310 a, b and 312 than in the outer support structure 304.

Any or all of the weakened regions 310 a, b and 312 may be configured toform a hinge or to perform the function of a hinge, for example byextending about the optical axis OA by a relatively smallcircumferential distance, for example less than about 2 mm, preferablyless than 1 mm, and more preferably less than 0.5 mm. Alternatively, anyor all of the weakened regions 310 a, b and 312 may be configured toform an elongated region in which the weakened regions 310 a, b and/or312 deform by varying amount along the region in response to the ciliarymuscle 34 and/or the capsular bag 22. Such an elongate regions ispreferably greater than about 2 mm and may be, for example, betweenabout 2 mm to about 3 mm or between about 3 mm to about 5 mm or evengreater than 5 mm.

Referring again to FIG. 20, for example, the intermediate weakenedregions 312 may be circumferentially disposed equidistant orapproximately equidistant between first and the second intermediatemembers 308 a, b. In some embodiments, the outer support structure 304comprises a first arm 314 and a second arm 318 separate and distinctfrom the first arm, the first arm 314 being connected or coupled to thefirst weakened region 308 a located near the first intermediate region308 a and second arm 318 being connected or coupled to the firstweakened region 308 a located near the second intermediate region 308 b.

Referring to FIGS. 23 and 24, in certain embodiments, the first andsecond arms 314, 318 are separate and distinct and the IOL 300 furthercomprises a void 320 between the first arm 314 and the second arm 318.Such separation between the first and second arms 314, 318 may be usefulin providing a predetermined performance of the outer support structure304 and/or the first and second intermediate members 308 a, b inresponse the ciliary muscle 34 and/or the capsular bag 22. For example,referring to FIG. 23, the void 320 between the first and second arms314, 318 may be configured so that the arms slide toward one another,but do not twist or buckle, as the outer support structure 304 iscompressed in response to contraction of the ciliary muscle 34. In suchembodiments the first and second arms 314, 318 may also rotate relativeto the first and second intermediate members 308 a, b. Preferably, thevoid is sufficiently large that the distal ends of the first and secondarms 314, 318 adjacent the voids 320 do not touch when the outer supportstructure is in its most compressed configuration within the eye.

Referring to FIG. 24, at least a portion of the first arm 314 may beslidably disposed to at least a portion of the second arm 318. Forexample, the first and second arms 314, 318 may be configured to pressagainst one another at their distal end and to slide as the capsular bag22 changes shape during accommodation. Alternatively, the distal ends ofthe first and second arms 314, 318 may be kept in close contact with oneanother by using clamp or other appropriate device (not shown) formaintaining the distal end in contact with one another as the outersupport structure is compressed and/or expanded during accommodation. Insome embodiments, the first and second arms 314, 318 is configured sothat the distal ends are in close proximity to one another, but are notnecessarily or always in contact with one another as the outer supportstructure 304 is compress and/or expanded.

Referring to FIG. 25, the IOL 300 may comprise a third intermediatemember 324 extending between and connecting the optic 302 and the outersupport structure 304. Additionally or alternatively, the outer supportmember may be configured to be circular, as illustrated in FIG. 25,rather that oval shaped, as illustrated in FIGS. 20-24. In theillustrated embodiment shown in FIG. 25, the IOL 300 may furthercomprise the intermediate weakened regions 310 shown in FIGS. 20-22 (notshown). Also, the weakened regions 310 a, b and/or 312 for theembodiment illustrated in FIG. 25 may have any of the structures orconfigurations discussed with regard to the embodiments discussed forFIGS. 20-24, where appropriate.

Referring again to FIG. 20, the intraocular lens 300 may comprise theoptic 302 and the outer support structure 304, wherein the outer supportstructure 304 completely surrounds or encircles the optic 302 and theintermediate members 308. In such embodiments, the intermediate members308 extend between and couple or connect the optic 302 and the outersupport structure 304. Also, the outer support structure 304 comprises afirst weakened region 310 a disposed proximal the first intermediatemember 308 a and a second weakened region 310 b disposed proximal thefirst intermediate member 308 a. The first and second weakened regions310 a, b are configured to allow angular motion between the firstintermediate member 308 a and the outer support structure 304 inresponse to the ciliary muscle 34 of the eye.

The configuration, number and location of the weakened areas or portionsor of the hinges in each of the illustrated embodiments are intendedmerely to be illustrative and, in practice, will depend on variousfactors such as the number and configuration of the intermediatemembers, the materials used, and the mode of deformation desired.

Furthermore, the outer support structures and outer rings andintermediate members in the IOLs of the embodiments in each of the FIGS.1-25 are not intended to be limited to use with optics of any particularstructure or type of material. For instance, the optics may be formed ofrigid biocompatible materials such as polymethyl methacrylate (PMMA) ordeformable materials such as silicone polymeric materials, acrylicpolymeric materials, hydrogel polymeric materials, and the like. Inaddition, the optic bodies may be either refractive or diffractive.

In the most preferred embodiments, the optic body has a diameter in therange of about 3.5 to about 7 mm and, optimally, in the range of about 5mm to about 6 mm. The overall diameter of the IOL, including theintermediate members and outer ring in unstressed conditions, ispreferably about 8 mm to about 13 mm. Additionally, the optic has afar-vision correction power for infinity in an unaccommodated state.

A series of tests were run on a prototype IOL in order to evaluate theperformance of the IOL under compression. The prototype IOL had theconfiguration of IOL 120′ shown in FIG. 18A and was formed entirely of aunitary, reinforced cross-linked silicone polymeric material of the typedescribed in Christ U.S. Pat. Nos. 5,236,970, 5,376,694, 5,494,946,5,661,195, 5,869,549, and 6,277,147. The disclosures of each of theseU.S. patents are incorporated in their entirety herein by reference.

During the tests, it was observed that, when the IOL 120′ was compressedan amount in the range of about 0.3 mm to about 1 mm, the image qualityin the far zone 132 improved slightly, while the image quality in thenear zone (add power=2D), decreased slightly.

Referring to FIGS. 26 and 27, in certain embodiments, an equiconvexoptic 304 comprises surfaces 306, 308. Those of skill in the art willrecognize that the optic 304 may be characterized by a focal length f(e.g., f₁ in FIG. 26 and f₂ in FIG. 27) produced as light 310 isrefracted by the surfaces 306, 308. It will also be recognized by thoseof skill in the art that the diopter power D of the equiconvex optic 304is equal to 1/f, when f is in units of meters. For isotropic compression(e.g., d₁, d₂ in FIGS. 26 and 27, respectively) or deformation (e.g.,deformation of the surfaces 306, 308 illustrated in FIGS. 26 and 27) ofthe equiconvex optic 304, there exists a relationship between the amountof diametric compression d (i.e. decrease in refractive zone size; forexample d₁-d₂) and the increase in diopter power (for example D₂-D₁).With an increase in diopter power (e.g., from D₁ to D₂), at least someimprovement in near vision can be expected. Referring again to FIG. 18A,by combining the increased diopter power obtained through deformation ofthe optic 126′ with that obtained through axial movement, it is believedthat enhanced accommodation can be achieved. In other words, a patient'spresbyopia can be effectively reduced. Still better accommodation, orfurther reduction of presbyopia, can be obtained from the add power inthe near zone 134 of a multifocal optic 126′, or from the maximum addpower of an aspheric optic.

Although the aforementioned tests were performed on an IOL 120′ formedof a reinforced cross-linked silicone polymeric material, the principlesof the invention will apply equally well to accommodating IOLs formed ofany ophthalmically acceptable, deformable material or combination ofmaterials. For instance, one or more of the optic 126′, intermediatemembers 122′, and outer ring 124′ may be formed of an acrylic polymericmaterial. Particularly useful materials and combinations of materialsare disclosed in U.S. patent application Ser. No. 10/314,069, filed Dec.5, 2002.

Furthermore, while each of the accommodation assemblies illustratedherein comprises an outer ring surrounding and spaced from the opticwith voids therebetween, and a plurality of intermediate membersextending between and connecting the optic and the outer ring, theseassemblies are merely exemplary. Other assembly configurations capableof effecting both axial movement and accommodating deformation of theoptic are also included within the scope of the invention. For instance,accommodation and/or force transfer assemblies of the type shown in theaforementioned co-pending, commonly assigned U.S. patent applicationSer. Nos. 09/656,661, 09/657,251, and 09/657,325, may also be suitable.

While the present invention has been described with respect to variousspecific examples and embodiments, it is to be understood that theinvention is not limited thereto and that it can be variously practicedwithin the scope of the following claims.

1. An intraocular lens for insertion into the capsular bag of an eye,comprising: an optic disposed about an optical axis; a support structurecomprising: an outer periphery defined by an intersection of an outerradial extent of the support structure and a plane perpendicular to theoptical axis; an outer structure comprising first and second arcuatearms, each arm being continuously disposed along the outer periphery,the outer structure being spaced from the optic; a first intermediatemember operably coupled to the optic and the outer structure; and firstand second weakened regions disposed along the outer periphery, thefirst weakened region circumferentially disposed between the firstarcuate arm and the intermediate member, the second weakened regioncircumferentially disposed between the second arcuate arm and theintermediate member.
 2. The intraocular lens of claim 1, wherein theouter periphery is circular.
 3. The intraocular lens of claim 1, whereinthe outer periphery is elliptical.
 4. The intraocular lens of claim 1,further comprising a second intermediate member extending between andoperably coupling the optic and the outer structure.
 5. The intraocularlens of claim 4, further comprising a third intermediate memberextending between and connecting the optic and the outer structure. 6.The intraocular lens of claim 4, wherein the outer structure furthercomprises at least one intermediate weakened region circumferentiallydisposed between first intermediate member and the second intermediatemember.
 7. The intraocular lens of claim 6, wherein the at least oneintermediate weakened region is circumferentially disposed equidistantbetween first intermediate member and the second intermediate member. 8.The intraocular lens of claim 1, wherein at least one of the weakenedregions comprises a hinge.
 9. The intraocular lens of claim 1, whereinat least one of the weakened regions has a radial thickness that is lessthan a radial thickness of the outer structure in a region proximal theat least one weakened region.
 10. The intraocular lens of claim 1,wherein at least one of the weakened regions has a thickness along theoptical axis that is less than a thickness along the optical axis of theouter structure in a region proximal the at least one weakened region.11. The intraocular lens of claim 1, wherein the outer structure is madeof a first material and at least one of the weakened regions is made ofa second material that is more bendable than the first material.
 12. Theintraocular lens of claim 1, wherein the outer structure comprises afirst arm and the second arm with a void therebetween.
 13. Theintraocular lens of claim 12, wherein at least a portion of the firstarm is slidably disposed to at least a portion of the second arm.
 14. Anintraocular lens for insertion into the capsular bag of an eye,comprising: an optic centered about an optical axis; an outer peripherydefined by an intersection of a maximum outer radial extent of thesupport structure and a plane perpendicular to the optical axis; anouter structure continuously disposed along the outer periphery; and afirst intermediate member radially disposed about a line intersectingthe optical axis and extending between and operably coupled to the opticand the outer structure; wherein the outer structure includes first andsecond weakened regions disposed on opposite sides of the line.
 15. Theintraocular lens of claim 14, wherein the outer structure is elliptical.16. The intraocular lens of claim 14, further comprising third andfourth weakened regions disposed along the outer periphery proximal thefirst intermediate member and circumferentially disposed on oppositesides of the first intermediate member.
 17. The intraocular lens ofclaim 16, wherein the outer structure further comprises at least oneintermediate weakened region circumferentially disposed between firstintermediate member and the second intermediate member.
 18. Theintraocular lens of claim 17, wherein the at least one intermediateweakened region is circumferentially disposed equidistant between firstintermediate member and the second intermediate member.
 19. Theintraocular lens of claim 16, wherein at least one of the weakenedregions comprises a hinge.
 20. The intraocular lens of claim 16, whereinat least one of the weakened regions has a radial thickness that is lessthan a radial thickness of the outer structure in a region proximal theat least one weakened region.
 21. The intraocular lens of claim 16,wherein the outer structure is made of a first material and at least oneof the weakened regions is made of a second material that is morebendable than the first material.
 22. An intraocular lens for insertioninto the capsular bag of an eye, comprising: an optic disposed about anoptical axis; a support structure disposed about the optic, comprising:an outer periphery defined by an intersection of a maximum outer radialextent of the support structure and a plane perpendicular to the opticalaxis; an outer structure comprising a first elongate element having afirst weakened region and a second elongate element having a secondweakened region, each elongate element being continuously disposed alongthe outer periphery; and an intermediate member operably coupled to theoptic and the outer structure; wherein the first and second weakenedregions are disposed along the outer periphery and on opposites sides ofthe intermediate member.